运动皮层电刺激治疗中枢性卒中后疼痛四例并文献复习

Motor cortex electrical stimulation for the treatment of central post-stroke pain:a report of 4 cases and literature review

目的分析总结运动皮层电刺激(MCS)治疗中枢性卒中后疼痛(CPSP)的经验及临床应用。方法选择武装警察部队特色医学中心疼痛科自2020年1月至2021年12月行MCS治疗的4例CPSP患者为研究对象,记录患者术前及术后2周、6和12个月的疼痛数字评分(NRS)及疼痛缓解率。结果4例患者术后测试调控阶段NRS 2~3分,缓解74%;术后2~6个月NRS 3~5分,缓解50%;调节刺激参数后疼痛再次得到缓解,术后6~12个月NRS 1~3分,缓解76%。4例患者四肢肌力与术前相同,术后均未发生硬膜下积液、血肿、偏瘫、癫痫、感染等并发症。结论MCS是治疗药物难治性CPSP患者安全有效的方法之一,可提升患者生活质量。MCS的疗效取决于患者的正确选择、电极的准确定位和参数的优化调整。

Objective To analyze and summarize the experience of motor cortex electrical stimulation(MCS)in the treatment of central post-stroke pain(CPSP),and to discuss the clinical application of MCS.Methods Four CPSP patients who were treated with MCS from January 2020 to December 2021 in the Pain Department of the Special Medical Center of the Armed Police Force were selected as the study subjects,and their pain numerical scores(NRS)and pain relief rates were recorded before and 2 weeks,6 months and 12 months after surgery.Results The NRS of 4 patients during the postoperative control stage was 2-3 scores,with 74%remission;After 2-6 months of surgery,NRS scores of 3-5 and 50%remission;After adjusting the stimulation parameters,the pain was relieved again,with the NRS 1-3 scores and 76%remission at 6 to 12 months after surgery.The muscle strength of the limbs of the 4 patients was the same as before,and there were no complications such as subdural effusion,hematomas,hemiplegia,epilepsy,and infection after operation.Conclusion MCS is one of the safe and effective methods to treat refractory CPSP patients,which can improve the quality of life of patients.The efficacy of MCS depends on the correct selection of patients,the accurate positioning of electrodes and the optimization of parameters.